The word fusion when it comes to the spine mostly has a negative connotation for patients and referring doctors. What we tell patients about fusion surgeries is that the procedure itself isn’t bad, but the results can be bad if it is performed incorrectly, in the wrong patient or at the wrong time. Having said that, we believe in avoiding spinal fusions if at all possible.

A Comprehensive, Multimodality Treatment Plan

Generally, a comprehensive multimodality treatment plan should be tried before a fusion surgery should be considered. The initial treatments should include an oral medication regimen, physical therapy and spinal injections. Oral medications may include NSAIDS such as ibuprofen or narcotic medications such as morphine. NSAIDS are available over the counter but some require prescriptions. Common side effects include an upset stomach, stress on the kidney and bleeding concerns due to antiplatelet activity. Narcotic side effects tend to be more severe and include constipation/nausea, drowsiness, as well as developing dependency/addiction. Muscle relaxants can also be used, particularly at night since a common side effect is sedation. Oral steroids can be used episodically but cannot be used in a sustained manner. Common side effects when used for a week is hyperglycemia, heightened emotions, heart palpitations, and increased appetite. Nerve pills are increasingly used as an adjunct to traditional analgesics. These medications are generally FDA approved for peripheral neuropathy but is often used in spine patients. A combination of all or some of these medications should be tried under supervision of a physician.

If the spine pain is improved on these medications, a session of physical therapy emphasizing proper spinal mechanics, stretching and core conditioning can be helpful. If the oral medications did not provide adequate pain relief enough to start physical therapy, directed injections often can provide the additional pain relief needed. These injections may include epidurals, nerve root blocks, or facet blocks. They usually contain a combination of steroids and a local anesthetic and are injected near the source of pain.

Other treatment modalities include acupuncture and massage but these are often not covered by insurance. Losing weight and cessation of smoking has also been shown to benefit patients with spinal pain. Other non-mainstream spinal procedures that are performed and talked about include laser procedures, stem cell injections, platelet rich plasma therapy (PRP).

When Spine Fusion Surgery is The Best Option

In certain cases, a fusion procedure is the best option for the patient. Patients who benefit from fusion typically have mechanically incompetent joints in the spine which are causing back pain and/or leg pain. The most commonly affected joints are worn out discs. Terms such as degenerated, herniated, ruptured or protruding are used to describe these discs.

The other joint in the spine are facets which are smaller and are located in the posterolateral aspect of the spinal column. These joints can also cause back pain. In these cases, performing a non-fusion spinal surgery is a disservice to the patient because a reconstruction procedure is necessary to address the mechanical issues. This is most commonly a fusion but in certain cases, an artificial disc may be possible. An artificial disc in the lumbar spine is indicated in patients with a 1 level worn out lumbar disc without significant facet disease.

Another common reason for a lumbar fusion is a degenerative spondylolisthesis which is a slipped vertebra due to a weak, degenerated disc. In these cases, a fusion can sometimes be avoided if the main pain is in the legs and not the back. Alternatives in these cases include a careful microdecompression which is designed to relieve pressure on the nerves while minimizing additional spinal instability. An interlaminar distraction implant can also be surgically placed which can in selected patients achieve a good outcome.

Get a Second Opinion

At Atlantic Brain & Spine, we want you to be aware of all treatment options available to you, including nonsurgical options. Before you elect to have back surgery, we encourage you to get a second opinion. In many cases, nonsurgical methods may be your best option.

If you’re family physician has recommended that you consider surgical options, or if you’d like to learn more about your options for treatment, including both surgical and nonsurgical, schedule a consult with Dr. Lim.